In stark contrast to the extraordinary lengths to which patients in wealthy countries will go to treat ischemic cardiomyopathy, young patients with nonischemic cardiomyopathies in resource-poor settings have received little attention. These conditions account for as many as 25–30% of admissions for heart failure in sub-Saharan Africa and include poorly understood entities such as peripartum cardiomyopathy (which has an incidence in rural Haiti of 1 per 300 live births) and HIV cardiomyopathy. Multidrug regimens that include heart failure beta-blockers, ACE inhibitors, and other neurohormonal antagonists can dramatically reduce mortality risk and improve quality of life for these patients. . | Chapter 002. Global Issues in Medicine Part 10 In stark contrast to the extraordinary lengths to which patients in wealthy countries will go to treat ischemic cardiomyopathy young patients with nonischemic cardiomyopathies in resource-poor settings have received little attention. These conditions account for as many as 25-30 of admissions for heart failure in sub-Saharan Africa and include poorly understood entities such as peripartum cardiomyopathy which has an incidence in rural Haiti of 1 per 300 live births and HIV cardiomyopathy. Multidrug regimens that include heart failure beta-blockers ACE inhibitors and other neurohormonal antagonists can dramatically reduce mortality risk and improve quality of life for these patients. Lessons learned in the scale-up of chronic care for HIV infection and TB may be illustrative as progress is made in establishing means to deliver cardiac therapies over a background of careful fluid management with diuretic drugs. Because systemic investigation of the causes of stroke and heart failure in sub-Saharan Africa has begun only recently little is known about the impact of elevated blood pressure in this portion of the continent. Modestly elevated blood pressure in the absence of tobacco use in populations with low rates of obesity may confer little risk of adverse events in the short run. In contrast persistently elevated blood pressure above 180 110 goes largely undetected untreated and uncontrolled in this setting. In the Framingham cohort of men 45-74 years old the prevalence of blood pressures above 210 120 declined from in the 1950s to in the 1990s with the introduction of effective antihypertensive agents. While debate continues about appropriate screening strategies and treatment thresholds rural health centers staffed by nonphysicians must quickly gain access to essential antihypertensive medications. In 1960 Paul Dudley White and colleagues reported on the prevalence of cardiovascular disease in the region near .
